Evaluation and treatment of communication disorders

♦ Referral to a speech and language therapist for early intervention with communication impairments, particularly dysarthria, should be considered for a variety of reasons:

O Effective speaking strategies may be learned with greater ease before the severity of dysarthria increases. O Early participation in speech therapy may foster later successful intervention. O Even a mild dysarthria can have a significant functional impact on an individual's communication abilities. O Completion of a comprehensive speech-language evaluation (123) is needed not only to determine the need for treatment, but to benchmark future changes in function in this progressive disorder. O Education regarding the expected course of communication involvement and the role of speech and language therapy can be provided for patients and their families.

Behavioural interventions (124)

♦ The Lee Silverman Voice Treatment (LSVT) has substantial literature supporting its beneficial effects and is a popular treatment choice for individuals with PD and hypokinetic dysarthria.

O LSVT emphasizes phonatory effort and uses maximum performance tasks as the basis of intervention. O LSVT also 'recalibrates' an individual's perceived level of effort with an emphasis on self-awareness. O LSVT is based upon the premise that treatment should be simple and intensive. O Although intact cognition is a positive prognostic indicator of success, LSVT can also be beneficial for patients with cognitive deficits.

♦ Other treatments which may be appropriate include rate control techniques and the use of delayed auditory feedback.

♦ Augmentative-alternative communication (AAC) treatment approaches may also be beneficial, particularly as dysarthria progresses.

O Voice amplifiers may be beneficial for increasing vocal loudness. O Pacing boards may assist in rate control.

Tasks for speech examination

Spontaneous speech

Reading aloud

Word and sentence imitation

Syllable repetition (i.e., diadochokinesis)

Vowel prolongation (i.e., maximum phonation duration)

Oral motor examination

Cranial nerve testing

123 Speech examination. A variety of tasks are used to assess speech function in patients with Parkinson's disease.

Selected behavioural treatments for hypokinetic dysarthria

Lee Silverman Voice Treatment (LSVT)

Maximum performance training

Expiratory muscle strength training (EMST)

Rate manipulations - delayed auditory feedback, pitch-shifted feedback, pacing boards

124 Behavioural treatments. A variety of treatments are available for speech rehabilitation in Parkinson's disease.

O Alphabet boards may be an effective strategy to supplement speech and provide context for communication partners. O Other AAC strategies such as communication boards/notebooks, voice output computer systems, and portable typing devices may also be used.

Effect of medications on communication

♦ For most individuals with PD, pharmacological treatment does not appear to have a significant beneficial impact on speech production.

♦ Hyperkinetic dysarthria, often in the presence of dyskinesias after prolonged levodopa therapy, may also be encountered.

0 0

Post a comment